Ask Polly

Dont Make the Physician Have The Hospice Conversation: Take The Burden Off Their Shoulders
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The physician should not have the difficult discussion about hospice with the patient and or the family. Every physician and staff have different comfort levels with and knowledge of hospice services. If they do not like to have the conversation (and most do not) or in any way are putting it off, the patient is not receiving hospice services as early as they should.

A great way to help demonstrate the commitment to meeting the needs of the patients and the families, you should offer to meet at the physician’s office to discuss hospice. Meet with the patient and or the family of a potential hospice patient anytime and anywhere and take the burden of the conversation off the physician’s (and their staff’s) shoulders.

Online Referrals: A Help or a Hassle?
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Ever order anything online? You select the items, you add them to the shopping cart, and then comes the dreaded “new customer” order form. How many times do you wish you could just wave a magic wand (or click a key) and all those empty name-address-credit card blanks would be filled in for you?

What’s in it for them? Many hospices have decided that their website can be used for something other than announcements, donations and service menus. That’s a good thing. What isn’t so good is when we decide to create interactive tools that make the customer do the work for us. First, we need to consider the reason we put up with the hassle factor when we order online:

~ It saves time. We don’t have to drive to the mall and wait in line at the checkout counter.

~ There’s more variety. We don’t have to go to another store to find the size we need or the style we want.

~ It’s private (hopefully). The clerk won’t snicker when you buy “What to Do if Your Life is a Mess.”

Time is prime: But do any of these reasons apply to our referral partners? There’s no advantage for them to order online unless it meets one of these needs. And the key need is saving time. It has to be easier than picking up the phone and reading a patient’s face sheet information to you. Well, that one is certainly a no-brainer.

Does it beat faxing? It has to be easier than throwing a face sheet in a fax machine. Many hospices have gone to a process in which the customer never has to pick up the phone. They just fax a face sheet and the hospice referral center confirms receipt of it within 10 minutes via a voicemail message to the referral source.

So here’s the real issue: In most cases, their software can’t talk to your software, so they can’t just attach something from their database. Instead, they have to fill in the blanks on your form, and we’re back to the hassle factor that all this was supposed to avoid. Does it mean we throw in the towel and stay stuck in a time warp? No! Here are some suggestions on how to make online referrals more user-friendly:

Limit the data demands. All you really need is:

~ Patient name
~ Family (or contact) name and phone number
~ Diagnosis (a dropdown menu may help)
~ Next step menu (see below)

Make it easy to transmit the referral information with as few fields as necessary. The more required answers, the more abandoned online referral forms.

Do not ask for any information that you can get from a faxed face sheet or a call to the family. That means no insurance information, social security number, birthdate, medications, history, etc. In fact, for hospital or nursing home referrals where you’re going to go anyway, no faxed information of any sort is needed. Get it from the chart when you get there!

Next step menu. This includes options such as “Call me before you do anything,” “I’m faxing a face sheet to you,” “Call the family today,” etc. You should also include an optional “Comments” section.

Test it with them first. Before you just post it on your website, talk to your key referral partners about what method works best for them. (They’ll never put e-mail first, because they’re in a time warp too.) But for those that use websites for medical information, as many do, have them look at a couple of your drafts and talk about what’s in it for them if they order online.

An easy update tool: When you receive an online referral, make that your ongoing communication tool. Just like when you order online, the website updates your shipping and delivery status. You can do the same for your referral source. Create a response message form that indicates where you are in the process, e.g., “message to family,” “visit scheduled (and date),” “consents signed,” etc. This way, you’re not playing phone tag or leaving multiple messages.

Previous Articles

Got an IPU? Beware the Mecca Syndrome
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Hospice inpatient units, either freestanding or in an existing care facility, are on the rise in many markets today. And most offer a very attractive alternative to other inpatient options, such as hospital floater beds or designated rooms in a nursing home.

Beauty can be a liability. However, our pride can get in the way of making sure we don’t oversell the unit. If we position it as too attractive, it becomes the premier place to be, resulting in delayed hospital discharges or disappointed families who thought they could just be admitted anytime.

We call this the “Mecca Syndrome,” in which the unit becomes the ultimate destination for patients and families at the end of life. And caring for the patient at home or in another setting can be perceived as second choice. To some, it’s almost a disappointment: “Well, I guess we’ll have to take him home (or keep him here) until we can get him admitted over there.”

Train (or retrain) your team. Oftentimes we have to undo the way the admissions team describes the IPU to patient and families. Talking about the beautiful wood floors, private rooms, garden views, and peaceful setting begins to sound like that dreamy trip to Bermuda. Their own home (or certainly the nursing home and hospital room) now feels second rate. Here are some tips to help manage the Mecca Syndrome for your hospice:

Don’t even bring up the IPU at admission unless the situation warrants it. If the patient is at home or in an assisted living facility, don’t mention it unless they are eligible for inpatient care or need assurance that there’s an inpatient option if needed later.

Reposition the unit. Here’s a better way to talk about the IPU: “Hopefully, your dad will be able to be cared for at home (or stay right here in the nursing home). That’s what most patients and families want. If he needs a level of care that can’t be provided at home, we have a care facility. But we’ll try to do everything possible to keep him here so that he doesn’t have to move anymore.”

Train (or retrain) discharge planners. It’s so much easier for a discharge planner at the hospital to tell the family that they can just go to the IPU than it is to work out alternative discharge plans. That doesn’t make them bad; it just makes their job easier.

Here are some tips to help with professionals:

1) IPU = referral call. Tell them that every time they think “IPU” to just call us instead and we’ll handle it from there. Will this work? Probably not, but it’s a start in the right direction.

2) If they call to ask if you have a bed, don’t say yes or no or that you’ll check to see. Instead, ask them about the patient and the situation first. Then, regardless of what they describe, tell them that you’ll meet with the family right away so that if they are eligible and a bed is (or becomes) available, everything will be ready to go.

3) Save the brochure. Don’t automatically include that lovely IPU brochure in all of your admission packets. But be sure to tell admission team members to carry it separately and offer it only as appropriate.

Make a Good First Impression!
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Take a look at your admission packet. The folder is bulging with pamphlets, fact sheets and forms, all with a mishmash of logos, fonts and layouts. It’s a mess!

Step 1: Sort the information - You know the drill: Some surveyor made a comment about some missing information six years ago, and it’s now evolved into a form that’s sacred for no good reason. First, take all your admission forms and sort the information into categories: program, insurance, privacy/records, consent, basic demographics, rights/responsibilities, etc.

Step 2: Streamline the repetitions - Your goal is to eliminate all repeated and redundant information.

Enter all the basic demographics on a face sheet, then remove all but the patient name and record # from every other form that the patient/POA signs. If it doesn’t have to be signed, it doesn’t need a name on it! And remember that every page of a signed document should have the name and record #.

Try to combine forms that require signatures so that the family only has to sign one page. You can use a small font, which is okay on documents that are rarely read anyway. Use bold headers that indicate what the paragraph is about, so that your nurse can more easily guide the family through the document.

Step 3: Make forms consistent - Now clean them up!

Crummy “copies of copies” look tacky so if you’re going to use a copier for form duplication, keep the original in a plastic sheath so that it’s clean next time.

Clean the imaging surface of the copier so that you don’t have those awful black dots all over the page!

Make a test copy before you run off 200 copies to be sure the original is aligned straight on the page! You should never have a copy that is more than a first generation copy. You do not need NCR forms with a peel off copy attached. Just make sure that an unsigned copy of the form is given to the patient.

While the font size may vary, use the same font and margin settings for every form. Make sure that your logo is on every header and that each footer contains the page number (e.g., “2 of 3” and your hospice name.

Your Website: Make It a Call to Action!
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The good news. Your website is up and running and you’re getting more and more hits every day. That’s what we’re finding as we work with clients to turn their website viewers into hospice users.

The bad news. Your website is still passive in terms of getting people to take action. You want them to either contact you via email or phone to schedule a visit, right? Then that needs to be a key feature of every page that consumers are likely to access.

The consumer call to action. Here’s a sample of what your banner should be on every consumer focused page:

“Contact us today for a free, confidential in-home visit. Hospice care or not, we’ll help you get the help you need.”

Note the important copy points:

~ Don’t use “evaluation” or “assessment.” Those terms sound too clinical, too official. You want this to be less threatening, so call it a visit.

~ Clicking on “Contact us” provides a direct link to send an email message to your hospice. It also offers a toll-free phone number if they want to call you instead. In both cases, the link is to your referral center.

~ By indicating “hospice care or not”, you can reduce the potential concern that this means it’s for hospice only. Remember, you want to be positioned as a resource regardless of the need.

~ Another option: Use “comfort care” instead of hospice care. Then you could change the phrase to: “We’ll help you get the services you need to stay comfortable at home.”

For professional referral sources. We want our referral sources to act as well, but in this case it’s not for them but for their patients. So on your nursing home, physician and hospital professional pages, use something like this:

“Contact us today to discuss your patients’ needs. At your request, we’ll meet with patients and families to help them get the help they need. Thank you for your trust in our hospice and palliative care services.”

Note that for professionals, we position the visit at their request so they know that they’re in charge of telling us what the next step will be.

The Message Matters
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1. Keep it simple! So many of the stickers and cards we see have multiple numbers to various locations printed all over the place. In addition, they list different procedures to follow and numbers to call depending on when the call is made (afterhours, weekends, etc.)

When someone panics about dad’s breathing, the last thing they need to be thinking is, “Is it after five? Is it Friday? Do I call the local number or the 800 number?” If you’re really telling them “We’re your 911”, then make it as simple as 911: One number, 24/7, no exceptions.

2. Sample messages. Remember, the key is to keep it simple. Here are some ideas:

~ Call us now.

~ Don’t hesitate.

~ 911? Call us instead.

~ We’re your 911.

~ Call us first!

3. No single number? If you don’t have just one number for active patients and their caregivers, then get one! (It’s unlisted, so the only people that have it are either existing patients or caregivers that had a patient on service.) If your service area has multiple area codes or some callers would pay a long-distance rate for placing the call, then use a toll-free number.

During the daytime, this patient help line could roll to your switchboard, to a team assistant or directly to a triage nurse. In the evening, it would roll to your answering service or your evening on-call team.

Asking the Big One: “How did you hear about us?”
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Why is it that this most crucial question in assessing your community marketing efforts is not asked nor discerned in 87% of consumer calls that aren’t referred by a physician? It’s because your staff is so busy talking to the caller (as opposed to listening to them) that they forget. In addition, they’re reluctant to ask because “it sounds like a sales person.”

If only they’d listen: If your call staff would focus on engaging the caller in a “tell me what’s happening” conversation, they wouldn’t have to ask most of the time because the “how they heard about us” part would be revealed within the story. But they’re usually so busy telling the caller about the program and all the hoops they have go go through just to be visited that the last thing they’re concerned with is how someone happened to call us today.

So here are some helpful tips:

~ Engage the caller: You have two ears and one mouth: Please use them in that proportion! Before you launch into a “wehave-itis” (we have nurses, aides, social workers") or “youhavetohave-itis” ("you have to have a terminal illness, less than 6 months, a doctor’s order, blah, blah"), say to the caller, “Sure, I’ll be happy to help you. Talk to me a little about what’s going on.” Ninety percent of the time, the caller will end up telling you how they heard about you. ("My friend Betty said her sister was in your program”, or “the nursing home said you go in there to help people”, or “I remember reading that article in the paper last month’).

~ If they don’t say how they got your name, wait until they’re finished and then say, “Well, I’m glad you called us. And how did you happen to hear about us?” If you engage the caller first, this doesn’t come across as a “sales” question. It’s asked out of curiosity and as a natural part of the conversation.

~ What call staff fear most is that they’ll sound like a telemarketer asking for a coupon code—and they will if they ask the question up front before they express any interest in the caller’s situation.

~ The irony: Many do sound like telemarketers because they start asking all the insurance and demographic information up front without having first shown any interest in the caller’s situation or reason for calling. And what’s worse, they’re clueless as to how insensitive they can sound in the process.

~ If you want answers, let them talk: Even if they “just want information” about your program, they have a reason for calling, and that’s what you must discern before launching into program details or asking the “how did you hear about us?” question.

Track all calls from all channels. There is absolutely no wrong answer to how the caller heard about your hospice program. As much information that can be trapped, should be recorded. Once you have a good database of this information you will be able to see what is and what is not paying dividends. You will be able to track back where you are getting your best and worst patients from. This is VERY important when dealing with “sister” organizations or other parts of your health care system. Knowing which of the professionals in the organization are most bought into hospice and particularly those who strongly advocate for YOUR hospice is very valuable. You can follow-up with them and reinforce positive behavior.

The End of Admissions
“Registration" Rules!
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Why is it that this most crucial question in assessing your community marketing efforts is not asked nor discerned in 87% of consumer calls that aren’t referred by a physician? It’s because your staff is so busy talking to the caller (as opposed to listening to them) that they forget. In addition, they’re reluctant to ask because “it sounds like a sales person.”

If only they’d listen: if your call staff would focus on engaging the caller in a “tell me what’s happening” conversation, they wouldn’t have to ask most of the time because the “how they heard about us” part would be revealed within the story. But they’re usually so busy telling the caller about the program and all the hoops they have go go through just to be visited that the last thing they’re concerend with is how someone happened to call us today.

So here are some helpful tips:

~ Engage the caller: You have two ears and one mouth: Please use them in tha porportion! Before you launch into a “wehave-itis” ("we have nurses, aides, social workers") or “youhavetohave-itis” ("you have ot have a terminal illness, less than 6 months, a doctor’s order, blah, blah"), say to the caller, “Sure, I’ll be happy to help you. Talk to me a little about what’s going on.” Ninety percent of the time, the caller will end up telling you how they heard about you. ("My friend Bettty said her sister was in your program”, or “the nursing home said you go in there to help people”, or “I remember reading that article in the paper last month.")

~ If they don’t say how they got your name, wait until they’re finished and then say, “Well, I’m glad you called us. And how did you happen to hear about us? “If you engage the caller first, this doesn’t come across as a “sales” question. It’s asked out of curiosity and as a natural part of the conversation.

~ What call staff fear most

What does “admission” mean to the average person? In the context of healthcare, it means going into a hospital. The vast majority of consumers think that hospice is a place (a facility or hospital) and are surprised when they learn that it’s primarily delivered in the home. Why perpetuate the myth? If you want to increase awareness about hospice home care, stop calling it an admission!

Call it “registration” instead: When a patient or family signs consents for hospice care, they’re really registering for your program. Even if they’ll be transferred to a nursing home or treated as an inpatient in the hospital, they’re still registering for your service.

Who cares what you call it? Every hospice should care, because the end users of the service are confused about where it takes place. When consumers associate admissions with acute hospital care, it just adds an additional barrier that you may have to break down in order to get them the help they need.

The registration nurse: If you have a separate admissions team, you’ll need to stop calling your nurse the “admissions nurse.” Call them the registration nurse instead.

What about Medicare? Medicare will continue to call it an admission, but that doesn’t mean you have to do the same. After all, in home health, we don’t tell patients that they’re being “485ed”!

Change form titles and brochures: Make sure that you change any reference to “admission” in your documentation titles and brochures. You don’t want to confuse your customer further by having them think that they have to go to a hospital!

Facility Referrals: Service is Number One Determining Factor
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In most facilities you will find that the hospice getting most of the referrals makes the process very easy. That translates into your representative getting a name and room number and taking it from there.

Some guide posts to use in the process:

1.  Every facility is different—make no assumptions about how they want things handled.

2.  Always wear your name badge and identify yourself and what you are doing before touching any patient records or charts.

3.  Always make sure that you leave the chart on top of the counter, in plain sight, at all times. Put any documents that you copy back in the chart, right where you found it, immediately.

4.  Ask permission to use their copy machine or facsimile before using it.

5.  Always yield to the facility employee. If they need to make copies, send a fax or use the chart, you should yield to them.

Remember, if there is any problem with the chart, the natural tendency will be to blame the problems on the hospice representative.

Caution: We cannot do the job of the discharge planner or social worker—that would be an illegal inducement. You can do the work necessary to ge the patient admitted to your service once you have the referral. This is not to be construed as legal advice (consult your hospice’s policies, procedures, and legal interpretations for exact guidance.)



After Hours Referral Calls: “Night Magic” or “Nightmare”?
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Virtually every hospice highlights its “24/7” service in its marketing materials. But too few hospices offer anything better than the 1970’s era answering service that we’ve all grown to hate if we have to contact a doctor after hours. One thing that you can bank on: the doctors hate it even more than we do.

No one likes to engage in a game of pager tag!

This is becoming a key service differentiator in many markets. It’s also one of the elements of service that you should be monitoring about your competitors to make sure you remain competitive.

~ Trash the answering service: If you want to be a true “value added” provider in your market, both admission and patient care inquiries need to be answered directly by your staff. Callers and patients know when it’s an answering service (the background clatter and/or lack of knowledge is a dead giveaway) and what makes it worse is the “if you don’t hear back from them in 10 minutes, call us again.” This is not the reassuring quality care service you need to be.

~ Evening coverage: For coverage from 6:00 - 10:00pm, referral lines should be forwarded to an admission nurse on call, who answers the inquiry and schedules a visit either imemdiately or the next day. Many hospices are now scheduling staff to be in the office and answer the phone lines in the referral center until 10:00pm and in some caes, around the clock—24 hours a day.

Taking evening rotation should be part of every team member’s job. (Many hospices pay extra to the on-call person if they need to do an urgent admission.)

Since it’s a rare occurrence for a referral to be made between 10:00pm and 8:00 am, the referral line can be forwarded to the on-call team for coverage during these night hours.

~ Scheduling capability: This means they have to know the admissions team schedule for the next day and have the capability to schedule a visit accordingly.

~ Don’t rely on on-call: Some hospices figure that they’ll just rely on the on-call staff to handle the inquires. Not a good idea. Guess where your precious referrals go? Right to the bottom of their list. And you can’t blame them. Their priority is managing patient care issues, not scheduling admission visits. The level of service or admission criteria cannot be determined by how busy the staff member is.

The same thing applies to inpatient units: Pass the calls to them and watch your after-hours referrals be banished to the ozone. This may seem counterintuitive, but we have seen many inpatient units that were complaining about empty beds yet turning down referrals! If you allow the inpatient unit staff to determine admission criteria, you’re guaranteed to lose admissions for all the wrong reasons.

~ Saturdays, Sundays and Holidays too: The same rules apply for direct referral capability on Saturdays, Sundays and Holidays. Hours should be at least from 9:00am - 5:00pm, with phones rolled to on-call after 5:00pm on these days.

Simple things can make for a really significant competitive advantage. Want to know what is most important to your referral partners? Ask them! Take the time to find out what they value most about your hospice and what they would change if they could. You will be amazed at how simple some of their requests are.

There are very large hospice programs who built their highly successful programs in extremely competitive markets by being available after 5:00, Friday afternoons and all weekends and holidays. These programs include ones who compete in markets with large hospital based hospices that capture most of the hospice discharges Monday thru Friday at 2:30. Sound familiar? Construct your program to meet these needs and watch the referrals pour in!

Be a market leader in these areas. Don’t wait around and then play catch up. Get ahead and stay ahead of the curve!

Great Service is Infectious and Fun
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Think of how much fun it is when things are working smoothly and everyone is happy. Now, stop and think about how that happened. If you can replicate that scenario on an ongoing basis, you are well on your way. However, if it is hard to remember the last time your agency felt like this or it happens for only fleeting moments, then you might want to rethink key strategies and focus systematically on your customer service profile. Your investment in building the best customer service will pay tremendous and long lasting dividends. This will translate into everything from greater profitability to more personal satisfaction, as well as many other tangible and intangible benefits.

Just ask yourself, “Do I look forward to coming into work every day?” “Does the rest of the staff?” This will give you a good sense of the areas that need improvement. It will also draw to the surface the rewards that await you with the successful implementation of your customer service program. If you want to have more fun, retain your current staff, and embrace rather than turn over your referral partners, the answer lies in the successful implementation of your customer service program.

Why strive for incredibly great service instead of just good service? What is wrong with good service? Primarily, the delivery of good service is not enough to differentiate you from your competition. Do you know of other hospices that provide good service? If you want to build solid customer relationships, you need to deliver superb service. If you want to inspire your staff, you must strive for excellence. People expect good service. However, they are WOWED by excellence. There is a buzz that surrounds incredible service organizations. People just want to be associated with them.